The long-term goal of this project is to improve renal and cardiovascular (CV) outcomes in patients with chronic kidney disease (CKD). There is an urgent need for clinical research designed to understand the causes and improve the detection, prevention, diagnosis and treatment of CKD and its complications. This application is a competitive renewal of a well integrated clinical research and training program designed to address this need. During the last funding period, I completed 6 clinical trials in patients with CKD, published 16 peer-reviewed papers, obtained a new RO1 grant and assumed leadership of a K30 training grant. Six fellows and 5 junior faculty, who I mentored during the last funding period, now have full-time academic appointments and extramural funding for clinical research. The specific aims of this proposal are to: 1) conduct clinical trials to identify therapeutic interventions that will improve renal and cardiovascular outcomes in patients with CKD using new approaches to prevent further loss of renal function and to reduce CV morbidity and mortality. These clinical trials will also serve as training vehicles for fellows and junior faculty where they can obtain practical experience in conducting high impact research, primarily supported from NIH funded grants;2) determine predictors of loss of renal function and cardiovascular outcomes in prospective studies including a recently collected population-based sample in Dallas County (Dallas Heart Study, DHS), the Reduction in Endpoints with the Angiotensin II Antagonist Losartan trial, and the African-American Study of Kidney Disease and Hypertension (AASK) study;and 3) expand and enhance training programs for post-doctoral fellows and junior faculty members in POR. Trainees will not only have experience conducting clinical trials but also experience performing cross-sectional and longitudinal studies. An expanded multidisciplinary team including both clinical and basic science researchers will provide didactic and practical experience in clinical research. All trainees will be enrolled in one of three programs: i) K30 POR;ii) Master's in Clinical Science or iii) a newly-established, institutionally-supported Clinical Scholar's Program that provides a guaranteed junior faculty appointment. This project will help advance the diagnosis, management and outcomes of patients with CKD and help to train the next generation of clinical researchers who will be prepared to become successful independent clinical researchers in nephrology.